Clinical usefulness of cerebrospinal fluid bacterial antigen studies

Maxson, Suzanne; Lewno, Mary Jo; Schutze, Gordon E.

doi:10.1016/s0022-3476(94)70201-2

Cited by 68 publications

(16 citation statements)

References 9 publications

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“…5,8,9 This has not been our experience, as only one out of five cases where Gram's stain was negative had a positive BADT. All cases with meningococcal meningitis had organisms on the Gram's stain, while BADT was only positive in half the cases tested.…”

Section: Discussionmentioning

confidence: 85%

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CSF Bacterial Antigen Detection Testing in the Diagnosis of Meningitis

Narchi

1997

Ann Saudi Med

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Bacterial meningitis carries a high mortality and morbidity if untreated or treated late. The success of parenteral antibiotic therapy depends on early diagnosis. Although cerebral spinal fluid (CSF) studies allow early presumptive diagnosis prior to initiation of treatment, broad spectrum parenteral antibiotics are currently administered, regardless of initial CSF results, if a bacterial cause is suspected, with the inherent risk of drug side effects and induction of bacterial resistance. CSF culture allows bacteriological diagnosis, but results are not immediate. Rapid identification of the offending organism by Gram's stain characteristics or bacterial antigen detection testing (BADT) allows chemoprophylaxis of contacts whenever indicated.The value of these two tests in CSF analysis has been contradictory in the literature, especially in patients with meningitis who received antibiotic therapy before the lumbar puncture was carried out. [1][2][3][4][5][6][7][8][9][10] The clinical usefulness of these tests should, therefore, be reassessed in light of the local epidemiology, immunization programs (Haemophilus influenzae type b [Hib] and Neisseria meningitidis) and the cost containment imperatives that all health care systems are currently encountering.We undertook to assess the clinical usefulness of CSF BADT and Gram's stain studies in children diagnosed as having meningitis in our institution, focusing on the bacterial cases and on all those who had been treated with antibiotics prior to lumbar puncture. MethodsAll cases of meningitis diagnosed in children under 14 years of age in our institution between January 1983 and June 1995 were analyzed. Patients were considered to have bacterial meningitis if the clinical presentation was suggestive and if parenteral antibiotic therapy for bacterial meningitis was given for at least seven days, with either a positive CSF culture or BADT, or if organisms were seen on Gram's stain, or in the presence of meningococcal septicemia with purpura and CSF. pleocytosis in the absence of a positive CSF culture.All medical records were reviewed and data collected included age, sex, antibiotic therapy before lumbar puncture, results of CSF analysis (total white blood cells [WBC] and differential, protein, glucose, Gram's stain, culture and BADT). CSF pleocytosis was defined as CSF WBC over 6 x 10 -6 /L (6 WBC/mm 3 ). BADT was carried out with Wellcogen ® Bacterial Antigen Kit, Murex Diagnostics Limited, Dartford, England. This kit uses rapid qualitative latex agglutination technique to detect specific polysaccharide surface antigens for Haemophilus influenzae type b (Hib), Streptococcus pneumoniae (Strep. pneumoniae), Escherichia coli (E. coli) K1, group B streptococcus and Neisseria meningitidis (N meningitidis) groups A, B, C, Y and W135 antigens. ResultsDuring the study period, a total of 98 cases of meningitis were diagnosed: 63 were aseptic (64.3%) and 35 bacterial (35.7%). A total of 20 children (20.4%) had received antibiotics prior to diagnosis. Gram's stain showed org...

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Section: Discussionmentioning

confidence: 85%

“…[1][2][3][4][5][6][7][8][9][10] The clinical usefulness of these tests should, therefore, be reassessed in light of the local epidemiology, immunization programs (Haemophilus influenzae type b [Hib] and Neisseria meningitidis) and the cost containment imperatives that all health care systems are currently encountering.…”

mentioning

confidence: 99%

CSF Bacterial Antigen Detection Testing in the Diagnosis of Meningitis

Narchi

1997

Ann Saudi Med

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“…A study of meningococcal meningitis patients showed a strong decline in the sensitivity of latex agglutination, from 60% for patients without antibiotic pretreatment prior to lumbar puncture to 9% for antibiotic-pretreated patients (43). The limited additional value of latex agglutination testing was also shown by several other studies, and its use is therefore limited (138,174,204,234,301).…”

Section: Latex Agglutination Testsmentioning

confidence: 97%

Epidemiology, Diagnosis, and Antimicrobial Treatment of Acute Bacterial Meningitis

2010

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SUMMARY The epidemiology of bacterial meningitis has changed as a result of the widespread use of conjugate vaccines and preventive antimicrobial treatment of pregnant women. Given the significant morbidity and mortality associated with bacterial meningitis, accurate information is necessary regarding the important etiological agents and populations at risk to ascertain public health measures and ensure appropriate management. In this review, we describe the changing epidemiology of bacterial meningitis in the United States and throughout the world by reviewing the global changes in etiological agents followed by specific microorganism data on the impact of the development and widespread use of conjugate vaccines. We provide recommendations for empirical antimicrobial and adjunctive treatments for clinical subgroups and review available laboratory methods in making the etiological diagnosis of bacterial meningitis. Finally, we summarize risk factors, clinical features, and microbiological diagnostics for the specific bacteria causing this disease.

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“…Others have found similarly low rates (2,24,26). Additionally, results from several studies have shown that positive BA test results rarely affect patient therapy (16,24,26). The low rate of positivity of this test as well as its minimal impact on patient care necessitate that the use of this test be reevaluated.…”

Section: Discussionmentioning

confidence: 94%

Quality assurance study of bacterial antigen testing of cerebrospinal fluid

Kiska¹,

Jones²,

Mangum³

et al. 1995

J Clin Microbiol

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Bacterial antigen testing (BAT) of cerebrospinal fluid (CSF) by latex agglutination is a low-yield procedure in patients whose CSF specimens have normal laboratory parameters. Between August 1992 and August 1994, we evaluated 287 bacterial antigen (BA) test requests to determine whether yields could be improved and whether patient costs could be reduced by canceling BAT for those patients with normal CSF parameters (cell count, protein, glucose) after consultation with physicians. A total of 171 (68%) BA tests were canceled by this approach. None of these CSF specimens was culture positive for an organism detectable by BAT. Of the remaining 116 CSF specimens tested, only 3 were positive by BAT, one each for Neisseria meningitidis, Streptococcus pneumoniae, and group B streptococcus. Only 43 of the CSF specimens tested had at least two abnormal parameters; the 3 positive CSF specimens were included in this group. In light of the low rate of positivity, the number of BA tests can be further reduced by establishing criteria that must be met before a CSF specimen is accepted for BAT. After review of our data and the literature concerning this topic, we concluded that only specimens with leukocyte counts of Ն50 cells per mm 3 should be tested. Of 287 specimens evaluated in our study, only 36 met this criterion, including the 3 BA-positive specimens. Enacting such a restriction would have reduced the total number of BA tests by 251 (87%) without compromising patient care. A laboratory cost savings of $6,500 per year would have been realized, with a substantial reduction in the cost per positive test. Patient charges would have been reduced by $12,500 per year.

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Clinical usefulness of cerebrospinal fluid bacterial antigen studies

Cited by 68 publications

References 9 publications

CSF Bacterial Antigen Detection Testing in the Diagnosis of Meningitis

CSF Bacterial Antigen Detection Testing in the Diagnosis of Meningitis

Epidemiology, Diagnosis, and Antimicrobial Treatment of Acute Bacterial Meningitis

Quality assurance study of bacterial antigen testing of cerebrospinal fluid

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